Initial ELE Determinations

Children (newborn through the month a child turns 19) who are active and receiving benefits on a SNAP, TANF, CC, WIC, or RCA case can have Medical Assistance eligibility determined according to ELE criteria as set forth in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009. The Division of Family and Children Services (DFCS) agency will utilize information collected when an application/renewal/change is completed by SNAP, TANF, CC, WIC, or RCA eligibility workers for services to determine eligibility. This data includes, but is not limited to all demographic data, proof of income, and household size.

If an application/renewal/change is received for a child younger than 19 years old, information provided by the family on that application/renewal/change or otherwise collected for the SNAP, TANF, CC, WIC, or RCA eligibility determination is used by the DFCS agency to determine most factors of Medical Assistance eligibility. During eligibility determinations, the DFCS agency will advise SNAP, TANF, CC, WIC, or RCA applicants/recipients that the information provided for the SNAP, TANF, CC, WIC, or RCA application/renewal/change will be shared with the DFCS agency for determining the children’s Medical Assistance eligibility, unless the individual chooses to opt-out on the initial application/renewal/change document or verbally during the SNAP, TANF, CC, WIC, or RCA interview.

DFCS should ensure that the child is not already enrolled in Medicaid (including SSI), PCK, or Medicare prior to an ELE determination. If a child(ren) under 19 Medical Assistance application is received and there is no active SNAP, TANF, CC, WIC, or RCA case, then an ELE determination cannot be completed.

The DFCS agency will use the SNAP, TANF, CC, WIC, or RCA income findings, calculated based on the specific program’s eligibility policies (income exclusions, disregards, household composition, deeming, etc.) to determine income eligibility for Medical Assistance. DFCS will use other information collected by the SNAP, TANF, CC, WIC, or RCA program on the application/renewal or through its verification processes to determine most other factors of Medical Assistance eligibility (e.g., verification of citizenship, State residency). Any SNAP, TANF, CC, WIC, or RCA eligible children that meet the specific program’s citizenship requirements, must also meet Medical Assistance citizenship requirements. A Reasonable Opportunity Period (ROP) for citizenship is allowed for ELE determinations. Refer to Section 2215-Citizenship/Immigration/Identity .

For Medical Assistance ELE determinations, DFCS should compare household income to the highest Medicaid income applicable to a child (0-19) which will be equal to 235% FPL. If household income is over 235% FPL but at or below 247% FPL, the child should be evaluated for ELE-PCK.

If a child is found eligible for PCK from the ELE determination, DFCS must provide notice that the child may qualify for Medicaid and/or lower premiums if evaluated using the regular eligibility determination and provide an avenue on how to request a full eligibility determination. A separate application is not required. Refer to Section 2194 - Peachcare for Kids® for ELE PCK premium amounts.

Children with third-party liability (TPL) are not eligible for PCK.

If the child’s Medical Assistance eligibility cannot be determined based on the processes used for ELE (e.g., the child is over income for PCK using the “Express Lane” agency’s income finding), a full eligibility determination must be conducted using the regular Medical Assistance processes. The income findings from the “Express Lane agency” should not be used, and additional information or verification should be requested from the family as necessary.

If a full determination is conducted based on a request or denial for any potential ELE applicant, the application is no longer considered ELE.

For ELE applications, retroactive months requested should follow the regular eligibility determination process.

It is the expectation that the ELE determination will be completed at the same time as the SNAP, TANF, CC, WIC, or RCA application/renewal but no longer than 45 days from the date ELE was requested.

If a client submits a Change Request for an already active SNAP, TANF, CC, WIC, or RCA case with a child younger than 19 years old, determine eligibility according to ELE criteria.

If the client has an approved ELE determination and would like to opt out of the ELE process and have a full Medical Assistance determination made, the client can call the DFCS call center at 1-877-423-4746 or complete the opt-out statement and drop off at their local DFCS office or upload online at gateway.ga.gov at any time.